A Revised Hemodynamic Theory of Age-Related Macular Degeneration

Abstract

Age-related macular degeneration (AMD) afflicts one out of every 40 individuals worldwide, causing irreversible central blindness in millions. The transformation of various tissue layers within the macula in the retina has led to competing conceptual models of the molecular pathways, cell types, and tissues responsible for the onset and progression of AMD. A model that has persisted for over 6 decades is the hemodynamic, or vascular theory of AMD progression, which states that vascular dysfunction of the choroid underlies AMD pathogenesis. Here, we re-evaluate this hypothesis in light of recent advances on molecular, anatomic, and hemodynamic changes underlying choroidal dysfunction in AMD. We propose an updated, detailed model of hemodynamic dysfunction as a mechanism of AMD development and progression.

Asian age-related macular degeneration: from basic science research perspective

“…There is a close association between the degeneration of the RPE and choriocapillaris. Although less attention has been paid to the role of the choroid in AMD, accumulating evidence suggests that the choriocapillaris and choroid also play a pivotal role in drusenogenesis, typical AMD and PCV [32]. First, there is an age-related thinning of the choriocapillaris and capillary lumen diameters [33].…”

Oral Delivery of a Tetrameric Tripeptide Inhibitor of VEGFR1 Suppresses Pathological Choroid Neovascularization

“…Aberrant ocular neovascularization is involved in many vision-threatening diseases including age-related macular degeneration (AMD), diabetic retinopathy (DR), central retinal vein occlusion (CRVO), retinopathy of prematurity (ROP) and corneal neovascularization. Among them, wet AMD accounts for about eight percent of all blindness worldwide and is the primary cause of blindness among the elderly in industrialized nations [1,2].…”

Epidemiology of age-related macular degeneration (AMD): associations with cardiovascular disease phenotypes and lipid factors

“…Gelfand and Ambati recently published a “revised hemodynamic theory of age-related macular degeneration”, adding to this vascular model [37]. They propose that drusen selectively localize and accumulate as a result of local hemodynamic parameters within the choriocapillaris, which then determines the severity and progression of disease towards both GA and/or neovascular AMD.…”